[Clinical implications of enlargement of left atrium]. / Klinické dôsledky zväcsenia lavej predsiene.

Enlargement of left atrium (LA) has been shown to be a barometer of diastolic burden and a predictor of common cardiovascular outcomes such as atrial fibrillation, stroke, congestive heart failure, and cardiovascular death. Different methods exist for the assessment of LA size. The American Society of Echocardiography recommended LA volume and its indexed value assessed by 2-dimensional echocardiography, to measure LA size. Current findings suggest that echocardiographically determined LA size may become an important clinical risk identifier in preclinical cardiovascular disease and should be assessed as a part of routine echocardiographic evaluation.

Obesity paradox and chronic kidney disease.

INTRODUCTION AND OBJECTIVES: In general population, obesity is associated with increased risk of adverse outcomes. However, the studies carried out in the past years have offered a new insight into obesity when associated with chronic disease states such as chronic heart disease, heart failure, chronic kidney disease, end-stage renal disease, etc. Studies of patients with these chronic diseases suggest that the outcomes of overweight and obese patients may be paradoxically better than in lean patients. The aim of our study was to identify how BMI can influence the renal and cardiac functions. METHODS: We carried out a retrospective study on 93 patients (51 males and 42 females; mean age 60.83 +/- 12.32 years) with chronic kidney disease in different stages of chronic renal failure according to K/DOQI. RESULTS: We found significantly higher GFR and lower creatinine levels in obese patients when compared to normal subjects (p = 0.0009, and p = 0.05, respectively). When comparing the group of obese patients (BMI >30) with normal subjects, we found significantly higher values of EF (p = 0.05) and S vel (global radial myocardial velocity of the left ventricle in systole; p = 0.04) in obese patients. There were no significant differences between these three groups of patients in other parameters such as B-type of natriuretic peptide, C-reactive protein, and fibrinogen (p = 0.2, p = 0.4, and 0.9, respectively). CONCLUSION: In our group of 93 patients with chronic kidney disease in different stages of chronic renal failure, we have proved no adverse effect of obesity on cardiac or renal function (Tab. 4, Fig. 3, Ref. 27).

[Why there is atrial fibrillation after cardiac operations?]. / Preco vzniká fibrilácia predsiení po kardiochirurgických operáciách?

Atrial fibrillation (AF) is the most frequent arrhythmias after cardiac operations. Its incidence ranges from 10-65%. Often there is a patient discomfort, prolongs hospitalization, increases costs of operation and may be permanent or recurrent course. The cause of postoperative AF is multifactorial. The prevention of non-pharmacological and pharmacological interventions. The conventional treatment strategies include monitoring ventricular rate, restoration of sinus rhythm and prevention of thromboembolic events. The development of effective therapies designed to decrease the high incidence of postoperative AF may be important in the future.

[BNP and echocardiographic parameters in patients with chronic kidney disease and dialyzed patients]. / BNP a echokardiografické parametre u pacientov s chronickými chorobami obliciek a dialyzovaných chorých.

We assessed the relation between BNP levels and some echocardiographic parameters of systolic and diastolic function of the left ventricle in 49 patients (mean age 69.39 +/- 8.47 years) with chronic kidney disease in different stages of chronic renal failure according to K/DOQI and in 45 subjects (mean age 52.6 +/- 14.85 years) on dialysis. Median for BNP in the group of patients with chronic renal failure was 132 pg/ml, and in dialysis subjects 320 pg/ml. None of our patients had clinical signs of heart failure during the last six months. Using a method of correlation matrix we found the left ventricular mass and its indexed value as a common indicator of increased BNP level in both groups of patients (dialysis patients, p = 0.0003, and p = 0.0005, respectively; patients with chronic renal failure, p = 0.03, and p = 0.04, respectively). Further analysis proved that in the group of dialysis patients the main determinants of increased BNP level were volumes of the left heart side: left ventricular end diastolic volume (p = 0.004), endsystolic volume (p = 0.01), and left atrial volumes (maximal, minimal, and total atrial stroke volume; p = 0.004, p = 0.009 and p = 0.04, respectively). In the group of patients with chronic renal failure the major contributors to increased BNP level were echocardiographic parameters of diastolic filling assessed from transmitral and pulmonary venous flow: E wave (p = 0.001), A wave (p = 0.01), E/A (p < 0.001), IVRT (p = 0.004), E/EDT (p < 0.0001), S wave (p = 0.01), D wave (p = 0.0003), S/D (p = 0.001), Ar duration (p = 0.02), and E/Vp (p = 0.003). No significant relation to left ventricular ejection fraction was found in both groups of patients. Our results suggest that the main determinant of increased BNP level in patients with different stages of chronic renal failure is diastolic dysfunction, whereas in dialysis patients high left heart volumes due to volume overload. The common denominator of high BNP level in both groups of patients is especially the left ventricular mass.

Left atrial volume as a predictor of heart function.

OBJECTIVES: This study was designed to identify an association between left atrial volume and systolic and diastolic functions of the left ventricle. BACKGROUND: Several studies have shown a relationship between the left atrial volume and different cardiovascular risk factors. METHODS: Transthoracic echocardiographic results of 268 patients (136 women and 132 men, mean age 60.2+/-17.3 years) were studied retrospectively. Key echocardiographic variables of systolic and diastolic function were related to the left atrial volume and its indexed value. RESULTS: The mean indexed left atrial volume in a subgroup of patients with normal echocardiography, was 25.3+/-6.7 ml/m2. Left atrial volume significantly (p<0.0001) increased in deteriorating diastolic function (impaired relaxation, pseudonormalized pattern, and restrictive physiology): 33.6+/-11.6, 48.7+/-21.8 and 84.5+/-60.5 ml/m2, respectively. There were also significant (p=0.0001) differences in cases with normal systolic function (EF>50 %) and systolic dysfunction (EF<50%): 37.9+/-24.1 vs 54.9+/-34.7 ml/m2. There were no significant differences in the left atrial volumes (33.1+/-10.9 ml/m2 and 38.3+/-15.4 ml/m2, p=0.13) in patients with normal systolic function and impaired relaxation compared to patients with systolic dysfunction. However, in both cases these values were different from those with normal echocardiography (p<0.0001). In multiple regression analysis the best predictor of enlarged left atrial volume was the left ventricular mass. CONCLUSION: We found a strong association between left atrial volume and left ventricular systolic and diastolic dysfunction. The strongest association appeared between increasing left atrial volume and left ventricular mass (Tab. 2, Fig. 4, Ref. 26). Full Text (Free, PDF) www.bmj.sk.